The aim of this study was to investigate potential morbidity associated with vascularized bone grafts (VBGs) in the elderly. We reviewed the charts of 33 patients 60 years of age (60-81 years, mean 67 years) who had been treated with a VBG because of intractable nonunion in an extremity. Preoperatively, we recorded their ages, presence / absence of infection at the site of nonunion, and physical status. Intraoperatively, we noted the grafting technique (pedicled or free), operating time, amount of surgical blood loss, and amount of perioperative transfusion. Postoperatively, bone union and surgical and systemic complications were assessed. Relationships between postoperative vascular complications or poor results and other factors were analyzed statistically. The patients who had postoperative vascular complications were older than those who did not (p=0.041, Mann-Whitney U-test). Postoperative vascular complications were related to the grafting method: Patients with free VBGs tended to have vascular complications more often than those with pedicled grafts (p=0.008,χ2 test). The pedicled VBG is therefore preferable in the elderly, although the indications are limited because of the condition of the graft site. Meticulous preoperative evaluation, atraumatic surgical procedure, and proper postoperative care are needed for good VBG results in the elderly.
